Challenges in the management of tumor-induced osteomalacia (TIO)

Tumor-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare acquired paraneoplastic disease, which challenging to diagnose and treat. TIO characterized by hypophosphatemia resulting from excess levels of tumor-secreted fibroblast growth factor 23 (FGF23), one the key physiological regulators phosphate metabolism. Elevated FGF23 results in renal wasting compromised vitamin D activation, ultimately osteomalacia. Patients typically present with progressive non-specific symptoms, including bone pain, multiple pathological fractures, muscle weakness. Diagnosis often delayed or missed due nature complaints lack disease awareness. Additionally, disease-causing tumour difficult detect localize because they are small, localizing symptoms signs, dwell widely variable anatomical locations. Measuring serum/urine should be an inherent diagnostic component when assessing otherwise unexplained fractures In cases inappropriate (sustained) phosphaturia inappropriately normal frankly low 1,25-dihydroxy D, differentiation potential causes include measurement FGF23, considered. While patients experience severe disability without treatment, complete excision curative dramatic reversal symptoms. Two additional current unmet needs optimizing management are: (1 2) considerable delay diagnosis consequent between onset surgical resection; (2) alternative management. These may addressed raising awareness TIO, taking into consideration accessibility variability different healthcare infrastructures. By recognizing challenges associated treatment applying stepwise approach clear clinical practice guidelines, patient care outcomes will improved future.